Provider Demographics
NPI:1104565548
Name:FREEMAN, BRANSON MICHAEL (LMSW)
Entity type:Individual
Prefix:
First Name:BRANSON
Middle Name:MICHAEL
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9415 E HARRY ST STE 800
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-5084
Mailing Address - Country:US
Mailing Address - Phone:316-652-2590
Mailing Address - Fax:
Practice Address - Street 1:9415 E HARRY ST STE 800
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-5084
Practice Address - Country:US
Practice Address - Phone:316-652-2590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12542104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker